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Health & Welfare Plans Newsletter

January 12, 2026

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[Guidance Overview]

FMLA Leave Calculation When Employers Close for Weather

"The DOL stated in [FMLA2026-1] that if an employee is scheduled to use less than a full workweek of FMLA leave, the time when the employer is closed for inclement weather will not be deducted from the employee's FMLA entitlement unless the employee was expected to work during the school closure. Conversely, however, the opinion letter states if an employee is scheduled to take a full workweek of FMLA during a week when the school is closed for part of the week, the entire week is counted against an employee's FMLA entitlement."  MORE >>

Jackson Lewis P.C.

[Sponsor]

Looking to cut GLP-1 costs in 2026?

Unpack the peer-reviewed data behind a new weight care model that drives better outcomes using less GLP-1. A must-read for benefit leaders looking to transition to a smarter, more affordable GLP-1 solution in 2026. Get the playbook today.

Sponsored by Embla

[Guidance Overview]

Mark Your Calendar: HIPAA Deadline on February 16

"A significant question arises as to whether the revised Notice must be delivered on paper or whether it can be provided by email. The HIPAA regulations generally require an individual to agree to receive an emailed Notice, but health plans and health care providers may consider whether that requirement strictly applies to the revised Notice. Plan sponsors and providers may also consider whether changes to other HIPAA-related documents are appropriate[.]"  MORE >>

Ballard Spahr LLP

[Guidance Overview]

IRS Extends Transition Relief for State-Paid Medical Leave Benefits

"[Rev. Rul. 2025-4] provided guidance on the federal tax treatment and reporting requirements of contributions to and benefits paid under a state-paid family and medical leave program.... The IRS recently extended this transition relief for medical leave (but not family leave) benefits paid in 2026 (Notice 2026-06).... [T]he IRS' reasoning in the Revenue Ruling, and thus the Notice, may provide insights on how the IRS views the withholding and reporting obligations under private plans."  MORE >>

Groom Law Group

[Guidance Overview]

Delaware Paid Family and Medical Leave Overview (PDF)

28 presentation slides. "Benefits from Delaware’s mandatory paid family and medical leave program are available for the first time in 2026. This slide deck provides an overview of the program, including significant rule changes made in 2025. It covers nonstandard requirements in areas like eligibility, employee waivers, the family member definition, claim administration and taxation."  MORE >>

Mercer

[Guidance Overview]

Pittsburgh Employers Face Mandatory Paid Sick Time Expansion

"As of January 1, 2026, employers whose full and part-time employees work within the geographical boundaries of the City of Pittsburgh are subject to expanded requirements of the Pittsburgh Paid Sick Days Act (PSDA).... [B]eginning in 2026, employees working within the city limits accrue paid sick time at a rate of one hour for every 30 hours worked.... [E]mployers with 15 or more employees must now allow employees to amass 72 hours of paid sick time per year. Smaller employers with under 15 employees must provide up to 48 hours of paid sick time annually."  MORE >>

Vorys

Factors to Consider Before Choosing a Self-Funded Group Health Plan

"[M]oving away from a fully insured plan could potentially lead to savings ... [Companies] might also avoid insurance mandates and pay less if fewer claims come in than what the insurance carrier had expected.... A self-funded plan provides greater insight into claims, enabling employers to tailor specific programs to what their employees and families need.... The level of compliance escalates with self-funded plans, and companies must evaluate if this added responsibility is worth the potential cost containment and care strategy for their population."  MORE >>

Forbes; subscription may be required

PBM's Definition of 'Retail Pharmacy' Could Mean 25 Percent Cap on Single Therapeutic Category

"Based on the specific language in this new provision, Optum appears to assure pharmacies that if credentialed as a specialty and/or compound pharmacy, the 25 percent cap on a single therapeutic category does not apply.... The key takeaway is that pharmacies must take a close look at and analyze their PBM agreements to determine whether they have a 'specific arrangement' (i.e., specialty or compound credentialing) that would render the 25 percent threshold policy inapplicable."  MORE >>

Duane Morris LLP

[Opinion]

ERIC Comment Letter to Virginia Bureau of Insurance on Proposed Amendments to Rules Governing Balance Billing for Out-of-Network Health Care Services (PDF)

"ERIC and our member companies are deeply concerned by a key provision of the Proposed Amendments that would require carriers to include outlier payments, made to out-of- network providers as a result of arbitration processes, when determining 'commercially reasonable' reimbursement rates. Specifically, the requirement ... that carriers 'develop and implement processes to analyze the outcome of arbitration decisions involving the same provider, CPT code, and geographic area in determining a commercially reasonable payment amount' would drastically skew calculated reimbursement rates and lead to higher system-wide health care costs."  MORE >>

The ERISA Industry Committee [ERIC]

Benefits in General

[Guidance Overview]

Initial Guidance Released on Trump Accounts

"To provide employer contributions, an employer must establish a Section 128(c) 'Trump account contribution program'  ... Employers that establish a Trump account contribution program will also be subject to similar requirements that apply to Section 129 Dependent Care Assistance Programs (DCAPs) ... regarding discrimination, eligibility, notification, statements, and benefits.... [C]ontributions can be made via salary reductions as a part of an employer's Section 125 cafeteria plan if the contribution is made to the Trump account of the employee's dependent[.]"  MORE >>

Sequoia

[Guidance Overview]

Trump Accounts: What's Still to Come?

"[IRS Notice 2025-68] lacked some details about the administration of Trump Accounts, such as guidance for employers on how they can fund the plans and roll money out of them for their employees.... The industry is still waiting for guidance on what trustees must do if the annual fees and expenses on a participant's investments change and exceed the 10 basis points, stated in the notice[.]"  MORE >>

PLANSPONSOR; registration may be required

Fifth Circuit Addresses Arbitration and Remedies in ERISA Dispute

"This decision is noteworthy insofar as it emphasizes the importance of drafting arbitration clauses to align with the parties' intent and because the Fifth Circuit did not adopt the approach of the Fourth Circuit in rejecting the make-whole remedy of surcharge in ERISA fiduciary breach cases." [Aramark Services, Inc. Group Health Plan, v. Aetna Life Ins. Co., No. 24-40323 (5th Cir. Dec. 18, 2025)]  MORE >>

Miller & Chevalier

Press Releases

Health-E Commerce®, WEX, Inc. Team Up to Simplify Tax-free Flexible Spending Accounts (FSAs) and Health Saving Accounts (HSAs) Accounts for Consumers and Employers

Health E-Commerce

Birches Health Appoints Cigna-Evernorth Veteran Andrew DiGiacomo as SVP of Strategy

Birches Health

Webinars, Podcasts and Conferences
(Health & Welfare Plans)

Voluntary Benefits and the Rising Risk for Employers

PODCAST

Williams Mullen

The GLP-1 Playbook: Rethinking Employee Health Strategy

February 10, 2026 WEBINAR

ebn

Fixing Mistakes: Health and Welfare Plan Edition

February 11, 2026 WEBINAR

Vorys

Last Issue's Most Popular Items

New USPS Rule Means Postmark Date May Be a Day Later Than Before

Ascensus

New Lawsuits Focus on Fiduciary Duties for Voluntary Benefits

Kutak Rock LLP

What Should Fiduciaries Expect in Health Plan Service Fee Disclosures?

PLANADVISER

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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